Two-step effective Onyx embolization from the occipital artery for the treatment of intracranial dural arteriovenous fistula: a technical note.

AIM: Trans-arterial embolization (TAE) using Onyx has recently been recognized as a curative treatment for dural arteriovenous fistulas (DAVFs). However, TAE for DAVFs with feeders from the occipital artery (OA) remains challenging because of the tiny and transosseous properties of the OA feeders. We report our experience and the technique of two-step effective Onyx embolization from OA for the obliteration of DAVFs with OA feeders.

MATERIAL AND METHODS: The medical records of patients with intracranial DAVFs treated with TAE using Onyx from the OA were retrospectively reviewed.

RESULTS: Seven patients were included. The methods of Onyx injection from the OA were categorized as simple Onyx injection into the shunt, and two-step embolization. Two-step embolization involved the Onyx or coil embolization of the OA distal to the branching site of the feeders in the first step, and Onyx was injected toward the target shunt in the second step. Simple Onyx injection was performed in two cases; in both cases, the residual shunt remained. By contrast, the two-step embolization technique was performed in five cases, and in all those cases, sufficient embolization of the DAVFs was achieved.

CONCLUSIONS: Prior embolization using Onyx or coil of the distal OA helped prevent Onyx from unexpected embolization through the subcutaneous branches that were not associated with the shunt, thereby leading to effective embolization. This new two-step embolization technique from the OA may improve the obliteration rate of DAVFs with OA feeders using TAE with Onyx.